Intubation

The introduction of a tube into a body orifice. The term usually is used to mean the introduction of a tube through the mouth or nose into the windpipe in order to maintain an adequate air passage into the lungs. It is carried out in general anesthesia, in cases of unconsciousness due to other causes, and in cases where the breathing is obstructed.

Gastric intubation, the passage of a tube into the stomach through the esophagus, is necessary in some cases of obstruction to the esophagus and in some cases of paralysis of the swallowing mechanism. It is used in cases of intestinal obstruction so that the contents of the stomach can be aspirated. It is also used to wash the stomach out in cases of poisoning.

Intubation is a great thing. It can secure an airway in an unresponsive patient for quite a while, it allows visual confirmation of an airway being secured, and it is generally pretty safe (just be careful with extubation). I taught quite a few students today how to intubate, and they all picked it up pretty quickly, and you can too.

Before we start, there are a few things that must be said. This is out of your scope of practice. Do not do this on a real person, unless you want to be sued. That being said, this is the way you do it.

The Equipment

To properly intubate, you first need the proper equipment. Professionals use a laryngoscope. A laryngoscope kind of resembles a mining-pick with a flashlight attached. The "blade" has two major varieties. The "Miller" blade is a straight edged blade (the 'l' in Miller is straight), and the "Macintosh" blade is curved (like the 'c' in Macintosh, get it?). For the purposes of this tutorial, lets assume you're using the Macintosh blade, because that's what I use. If you want a Miller tutorial, message me and I'll be happy to explain the differences.

You also need an ET (endotracheal) tube, which is what the air is going to go through, and a stylet, which will help guide the ET tube into the trachea. If a stylet isn't available, use a wire coat hanger. Some string is helpful, too.

With these items, you're ready to go.

The Procedure

Get behind your patient (henceforth male for pronoun purposes), and have your eyes on his level. If your patient is on the ground, you may either lay on your stomach behind him, or try to get as low as possible on your knees/elbows. You should be looking down the stretch of their body. Before you begin this procedure, if you have a partner who is bagging (giving oxygen) to the patient, have him or her hyperventilate the patient while you get ready. When you're shoving this down their throat, they aren't breathing.

The Idea

The basic idea of this procedure is that you are going to wrench their mouth open, visualize the trachea (windpipe), stick a tube in, and push air through the tube into their lungs.

Read this entire write up before you move on from this point. The next steps need to be completed quickly and accurately. Have your partner stop bagging, and remove anything from the patient's mouth. Stick in your laryngoscope (with a Macintosh blade), put the tip of the blade behind their tongue, and push forward and up. Don't try to use the blade as a lever, you'll shatter some teeth. Look inside the patient's mouth. You should see two holes. One is the esophagus, going to the stomach (the one on the bottom), and the other is the trachea, going to the lungs. Around the trachea you should see a slightly different colored piece of anatomy we call vocal cords.

With the trachea (the upper hole) visualized, stick in your ET tube (guided by the stylet). Make sure it goes in the right hole.

Stick it in another inch or so (after it's already in), take out the laryngoscope and stylet (leaving the ET tube in), and you're done. Push 10 mL of air into the small port of the ET tube (this blows up a bubble in the trachea so nothing gets past it), then push some air through the top of the ET tube to make sure the chest rises. You shouldn't hear any stomach noises. If you do, return to "Make sure it goes in the right hole." Use the string to secure the tube.

The entire process should take about a minute, give or take based on experience.

Hope this helps you should you ever need to perform an emergency intubation. Please don't hurt anybody with this.